Blood in the stool • It could be anything!

Many people have already seen a little blood on toilet paper. Small cracks in the sensitive skin of the anal canal (anal fissures) appear relatively quickly. For example, if the stool is hard and the person concerned is pressing hard. Hemorrhoids in the rectum (the last section of the colon) and anus are also common causes of anal bleeding. In addition, much more serious reasons can lead to this symptom: These include colon cancer.

Article content at a glance:

Forms of blood in the stool depending on where it occurs

Medical professionals call bleeding from the anus peranal bleeding. They differentiate between

• Bleeding from the anorectum (lower intestines), which are mostly harmless;

• Bleeding in the colon (large intestine) or in lower gastrointestinal tract (Gastrointestinal tract) where blood is mixed up with stool called hematochezia;

• Bleeding in the upper gastrointestinal tract, whereby the chair is tar-colored and is technically called Meläna (tarry chair).

Most people who present to the doctor's office with blood in their stool have hemorrhoids or anal fissures. However, there are other causes for blood that is deposited or contained in the stool. Tracking down these diseases or injuries is not easy for the attending physician because the source of bleeding in the gastrointestinal tract cannot always be identified immediately. This will require further research.

You should know about these causes of blood in your stool

Bleeding from the anus can have a variety of causes. If they come from the lower digestive tract (i.e. the colon, rectum or anus), the following causes are possible:

Hemorrhoids: How to Relieve Discomfort

Causes of bleeding from the small intestine:

• Tumors (rather rare)

• Malformations of blood vessels (angiodysplasia)

• Meckel's diverticulum (protrusion of the intestinal wall)

• Crohn's disease

Causes of bleeding from the upper digestive tract:

• Ulcer of the stomach or upper part of the small intestine (caused by infections with Helicobacter pylori or drugs such as non-steroidal anti-inflammatory drugs, for example acetylsalicylic acid, ibuprofen)

• Inflammation of the lining of the stomach (gastritis)

• Varicose veins of the esophagus (esophageal varices)

• Inflammation of the gullet (esophagitis)

• Mallory-Weiss bleeding of the esophagus due to violent vomiting with damage to the mucous membrane

• Angiodysplasia

• benign tumors

• Cancer of the esophagus or stomach

What does the color of the blood say?

Blood in stool from tissue damage in the lower intestinal tract is usually bright red. If the blood has traveled a long way, it is darker. Therefore, the consistency and color of the blood will provide the doctor with clues as to the possible cause or location of the bleeding. Sometimes, however, the blood cannot be seen with the eye, it is in the stool. In this case, medical professionals speak of occult blood.

What does light, dark and invisible blood mean?

Doctors differentiate between the following types of blood in stool:

• Concealed (occult) blood in the stool: Hidden blood in the stool can only be detected by a special stool test. The occult blood test, which should be carried out once a year from the age of 50, shows traces of blood that are not visible to the eye. With it, the doctor also receives information about colon cancer. Very little, if any, amount of blood can be seen. This is because colon polyps bleed only irregularly.

• Haematochezia (blood stool): Visible deposition or mixing of light to dark red blood on or with the stool. A visible deposit is when the blood on the stool is clearly visible. This blood is mostly fresh (bright red) and comes from an injury in the lower digestive tract. Bleeding from injuries in the upper part of the small intestine is usually a mixture of blood in the stool. Incidentally, the bright red blood that can leak out from hemorrhoids is not proof against colon cancer. Any blood in the stool can also be an indication of a tumor.

• Meläna (tarry stool): A tarry stool is a black coloration of the stool with an unpleasant pungent odor (smell of earth). The reason is usually bleeding in the upper digestive tract. Tar stools are caused by the blood moving slowly through the large intestine and being partially broken down by bacteria. If tar stools appear, the bleeding is usually several hours or even days ago. But bleeding in the lower digestive tract can also occur Tarry stool if the intestinal transit is particularly slow. If blood stool with light to dark red blood is due to bleeding in the upper digestive tract, this indicates severe blood loss. This is to be distinguished from the so-called Kindspech, the also black colored first bowel movement of newborns. It is not due to blood in the stool, but to bile.

Blood in the stool: this is how the doctor makes the diagnosis

Blood in the stool is never a normal condition: it can hide harmless but also serious diseases such as colon cancer. Therefore, if blood appears in their stool, those affected should always consult their family doctor or a gastroenterologist.

This is even more advisable if your bleeding is accompanied by general symptoms such as abdominal pain, diarrhea or constipation. Even those who feel sick and exhausted should consult a doctor. Blood in the stool is a common symptom in medical practice.

The doctor draws some conclusions about the possible cause from the nature of the symptoms, the appearance of the bleeding and the patient's history.

• During the anamnesis (taking the medical history), the doctor will ask, among other things, about existing previous illnesses, recurring abdominal complaints, alcohol consumption and the use of painkillers.

• If the bleeding is acute, the doctor first determines the bleeding intensity in order to assess whether it is an emergency or not. This is much more common for bleeding in the upper digestive tract than for bleeding in the lower digestive tract.

Which physical exams are useful

In particular, if hemorrhoids are suspected, the doctor first conducts a palpation examination. The so-called anoscopy (analoscopy) has proven itself as an additional diagnostic method. A colonoscopy may also be necessary.

Reflections of the stomach and intestines with blood in stool

If there is a suspicion of bleeding in the upper gastrointestinal tract, the doctor will perform an endoscopy of the gastro-intestine. Here he recognizes where the bleeding is and what is the cause. In most cases he closes the bleeding area during the procedure.

If the type of blood in the stool suggests bleeding in the lower digestive tract, a colonoscopy may provide information about the exact location of the bleeding and its cause. During this examination, too, the bleeding focus can often be closed during the procedure.

Imaging tests of the blood vessels

If it is impossible to identify the source of the bleeding by a reflection of the upper or lower gastrointestinal tract, an X-ray contrast examination of the blood vessels (angiography) and / or a scintigraphy (imaging examination with radioactive substances) follow.

If the source of the bleeding cannot be found despite all the examination measures, but profuse rectal bleeding persists, an emergency operation may have to be performed.

Haemoccult test: Examination of blood in the stool

Concealed blood in the stool is an indication of colon cancer. The examination for hidden blood, known as the haemoccult test, is therefore offered by the statutory health insurance companies as part of early cancer detection and prevention. From the age of 50, all legally insured persons can carry out a corresponding examination once a year free of charge. A small amount of stool must be applied to a test booklet on three consecutive days, tightly closed and given to the doctor after the test series has been completed. Even the smallest amounts of blood in the stool can be detected in this way.

If the result is positive, the doctor recommends a colonoscopy to determine whether it is actually cancer or another disease. From the age of 55 onwards, insured persons can choose: Either they have a test for concealed blood in their stool every two years or they have two colonoscopies at least ten years apart.

Regular tests for blood in your stool can save lives

If the test for hidden blood in the stool is carried out regularly once a year, according to experts, the death rate from colon cancer can be reduced by up to 33 percent. This is possible because tumors can be detected at an early stage with regular tests, although they are not yet causing any symptoms.

Nevertheless, experts believe that the hemoccult test is less effective than colonoscopy as an early detection and prevention method for colon cancer. Colonoscopies, as offered at least ten years apart as part of the statutory early diagnosis, reduce the mortality rate from colon cancer by an estimated 60 percent – and thus almost twice as much compared to the test for hidden blood in the stool.

The main therapies for blood in the stool

Treatment for bleeding depends on the cause of the rectal bleeding. Depending on the cause or clinical picture, there are different therapy options.

Overview: This is how rectal bleeding is treated

• At hemorrhoids Anti-inflammatory ointments for local application or suppositories containing cortisone have proven themselves. If necessary, obliteration of the vessels is indicated. In addition, those affected can do something themselves by eating a diet rich in fiber: Plant fibers from vegetables, fruits and grains prevent constipation and, as a result, hemorrhoids.

• For bleeding from one Diverticulum (Bulging of the intestinal wall) in the context of diverticulosis of the large intestine, it is recommended to surgically remove the affected section of the intestine after the second bleeding episode.

• Also at Colon cancer In most cases, surgery is carried out. Depending on the stage of the disease and the location of the tumor, further treatments are carried out (chemotherapy, radiation therapy, targeted therapies).

• Intestinal polyps, which are considered to be the preliminary stage of colon cancer, are usually removed by the doctor during the colonoscopy. This significantly reduces the risk of colon cancer – and the blood in the stool disappears.

• At a acute bleeding the doctor tries to stop them during the gastro-intestinal or colonoscopy. In doing so, it separates the bleeding vessel from the blood flow. If this is not possible, an emergency operation may be carried out. In the case of severe, acute bleeding, the circulation must be stabilized, for example by an infusion or the administration of donated blood (blood transfusion).